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Full text of "The progress of medicine at St. Bartholomew's Hospital"

v 






THE 



PROGRESS OF MEDICINE 



AT 



ST. BARTHOLOMEW'S HOSPITAL. 



1123-1888. 



EX LIBRIS 
1ARVEY CUSHING 



YALE 
MEDICAL LIBRARY 




HISTORICAL 
LIBRARY 



THE PROGRESS OF MEDICINE 



ST. BARTHOLOMEW'S HOSPITAL. 



AN ADDRESS 

DELIVERED AT THE 

OPENING OF THE SESSION 

OF 

THE ABERNETHIAN SOCIETY, 

OCTOBER 16th, 1888. 



NORMAN MOORE, M.D., F.R.C.P., 

ASSISTANT PHYSICIAN TO ST. BARTHOLOMEW'S HOSPITAL; WARDEN OP THE 

COLLEGE AND LECTURER ON PATHOLOGICAL ANATOMY TO THE HOSPITAL ; 

ASSESSOR TO THE REGIUS PROFESSOR OF PHYSIC IN THE 

UNIVERSITY OF CAMBRIDGE. 



LONDON: 

PRINTED nr 

ADLARD AND SON, BARTHOLOMEW CLOSE. 
1889. 



THE PROGRESS OE MEDICINE 

AT 

ST. BARTHOLOMEW'S HOSPITAL. 



When I was asked to give the opening address to the 
Abernethian Society this year I felt great difficulty in the 
choice of a subject. The range of medicine is wide, 
and of course it would have been easy to choose one of 
the many divisions of the science in the study of which 
all of us are spending our lives, but a subject of that 
kind, dealing with the advanced part of medical studies, 
is not perfectly suited to a meeting in which some of the 
audience have only just begun to study medicine, while 
others are so far advanced in it that they have already 
made additions to medical knowledge. 

Since one of the objects of the Abernethian Society is 
to further the advance of medicine, I have decided to 
endeavour to set forth the gradual progress of medicine 
at St. Bartholomew's, from the earliest times to the present 
day, as a subject likely to interest both those senior mem- 
bers of the Society who have ah'eady attained distinction 
in medical knowledge, and those junior members who are 
beginning their studies and ought to be encouraged to work 
for the day when their names may become illustrious in 
the history of St. Bartholomew's. 

I know no profession in which men are less likely to 
believe a thing because it has been stated for a very long 
time, than in that of medicine. This turn of mind, which 
is observable in students as well as in doctors, was almost 
the first thing that struck me when I came here from the 



4 

University. I can never remember, when I was at Cam- 
bridge, feeling the slightest hesitation or doubt about 
accepting as incontrovertible truth the statements of the 
distinguished persons who lectured to me on the De Falsa 
Legatione of Demosthenes, and the Epistle to the Colos- 
sians, and I was at first astonished and afterwards pleased 
to notice another disposition at St. Bartholomew's. A few 
days after coming here, I heard Sir James Paget make 
some remarks about a case as he went round a ward, 
when a student who was present differed from him on 
some point, and that distinguished surgeon, instead of being 
horror-struck at the student's presumption, took pains to 
prove that his own opinion was right, and on what grounds 
it was based. This peculiarity, I hope, will always continue 
to characterise students of medicine — this resolution not 
to accept anything which is not quite clearly put before 
them. This wholesome frame of mind, however, sometimes 
leads us to be too careless of what was done in former times. 
We are generally a little inclined to go too far on the side of 
believing in ourselves and our contemporaries, and there- 
fore I believe it to be of practical use for us now and then 
to consider how our present knowledge was acquired, as 
well as what it actually is, and to learn how men have 
reached the advanced stage in which we sometimes believe 
ourselves to be. The motive which has induced me to 
look into what has occurred in past times is that I hope 
from the past to learn something of actual use to us in the 
pi-esent. That is the reason I am anxious to lay before 
you to-night what is of course only a small fragment of 
the history of the progress of medicine in this Hospital. 

There is no place in England where that study may be 
more appropriately begun and followed up than in St. 
Bartholomew's Hospital. We are in the very middle of 
the sacred land of Medicine, and many of the great events 
in the history of Medicine in England are connected with 
the particular region in which our Hospital is, or have 
occurred in our Hospital itself. It has flourished as a 
Hospital on its present site for more than seven hundred 



and fifty years, and its Smithfield gateway, through 
which passed men of the generation whose fathers saw 
William the Conqueror enter London, has ever since been 
open to the sick poor. The College of Physicians, the 
first academical foundation of Medicine in England, was 
long situated within a few hundred yards of our gates. 
The founder of that illustrious College and most of its 
fellows for two centuries lived within a short distance 
of this Hospital. The place is surely appropriate to an 
examination of the prdgress of Medicine. 

How ought the inquiry to begin ? Clearly the basis of 
all medicine is the patient. A patient must be the very 
beginning, and is also the end of our study, so that I may 
rightly begin by endeavouring to discover who was the 
first patient and what was the nature of his disease who 
was admitted into this Hospital, and it is interesting to 
know that it is possible to discover the admission of a 
patient at a very early date. The earliest patient whose 
admission is recorded and whose symptoms are related is 
described in the life of our founder Rahere. I should 
recommend anyone who cares for the history of St. Bartho- 
lomew's to look at the manuscript when he goes to the 
British Museum. Anyone may get it out and examine it 
to his heart's content. It belonged to Sir Robert Cotton, 
who had in his library the busts of the Roman Emperors 
at the head of each of the book-cases, and the books were 
marked after the bust under which they happened to be 
placed, so this manuscript is known in the British Museum 
as Vespasian B.IX. This manuscript was actually written, 
as by comparing it with other manuscripts you may easily 
make sure, in the reign of Richard II. That is the 
period of its writing, but when you read it you will find 
that it is itself a copy of a manuscript of a much earlier 
date, composed in the reign of Henry II, within fifty 
years of 1123, the date of the foundation of this Hospital. 
It gives an account of the life of our founder, written by 
a man who had known those who knew Rahere, though 
he himself had not actually seen him. It is full of 



interesting particulars of the commencement of this place. 
In this manuscript is the account of the admission of the 
first patient of which we have any record. So you see 
there is clear and distinct documentary evidence of a 
patient admitted here in the reign of King Henry II. 

" An nothir man Adwyne by name in the towne of 
Dunwych 1 that dwellid on the see syde, so was contracte 
that he myghte nat use the free office, nethir of hande, 
ne of fote, his legges were clevynge to the hynder parte 
of his thyes, that he myghte nat goo, and his handis 
turnyd bakewarde, no thynge with them myght be do, ne 
worke : the extremyteis of his fyngers were so rigorisly 
contracte in the synowys, that he myght unneith put mete 
to his moweth. 3 In this grevous sykenes he passid his 
yonge age. And whan he attayned to mannys age and 
not yette hadde he power of his lymmys, yette sith the 
fame of tokenys and myracles of the blessid apostle come 
to hym by relacion of othir men, he began to leyfte up his 
sorowfull soule in to abetter hope. And thow helth 
were yn that tyine dilaid, it was promysed to come. 
The rf ore, for that he was ferre from that chirche, he 
yave shipmen for hyr hyyr and by shippe he was browght 
to the chirche, and put yn the hospitall of pore men. 
And ther a while of the almes of the same chirche y 
sustenyd. And he began yn the meyn while, by the 
vertu of the apostle to take breith unto hym, and he 
desirid helth,' by certeyn incrementys began to come 
ageyn ; ffirst with handys thow they were crokyd, he dyd 
make sniale workys as disstafes, and antell, 4 and othir 
wommenys instrumentys, and forthermore by succession, 
whan othir membrys usyd their naturall myghte he fol- 
lowid yn greter workys, hewerrys of wode with axe, 5 and 
squarerys of tymbyr with chippynge axe, 6 and nat longe 

1 Iu Suffolk. 

' vix ori escas porrigebat. 

3 ea optata sanitas. 

4 antell, percsa, weights. 

5 hewerrys of wode with axe, cesores lignoruui securi. 

6 et dolabra niagnis operilus imitabatur. 



aftir, the crafte of carpentrye, yn the same chirche, and 
yn the cite of London he exercisid, as it hadde be taught 
hym from his childehode, blessynge God, whoes yen, be 
oon them, that dredith hym, and uppon them that hope on 
his mercy." 

By ship he was brought to the Church, that, of course, is 
the Church of St. Bartholomew the Great, still standing 
in Smithfield, in connection with which at that time 
there was a Priory of Augustinian Canons. In this life 
there are many accounts of people who came to Rahere's 
tomb in the Church and believed themselves to be cured, 
and there is no reason to doubt that they did recover from 
the conditions in which they are described to have been. 
These cannot be reckoned as cases admitted into the hos- 
pital ; they were merely people who went to the church 
and performed their devotions there and weut away 
better than they came. But of this man, Adwyne, it is 
distinctly added he was admitted into the Hospital of 
poor men. By long lying in bed his muscles had become 
antemic and enfeebled. They evidently encouraged him 
in the Hospital to move his limbs a little, and he was able 
to move them much more than he expected ; he began 
to make small things, commencing with cutting and 
carving, and so at last was able to work again and to 
follow the craft of a carpenter. 

This is the first case of which we have any record in 
the Hospital, and the only admission to it mentioned in 
Rahere's life ; but though the condition of the patient is 
described no details of his treatment are given. He was 
discharged cured ; a fortunate beginning for our statistics. 

Our Founder began by building the Hospital and then 
went on to construct the Priory, of which St. Bartholo- 
mew's Church in Smithfield is the only remaining frag- 
ment. The Hospital was from the beginning indepen- 
dent, but Thomas, his successor, like Rahere himself, 
passed from the headship of the Hospital to that of the 
Priory, and the Canons profited by the proximity of a 
place of medical study. 



8 

The manuscript I have just quoted was composed in 
the reign of Henry II, but the oldest existing copy was 
made in the reign of Richard II, and it is in that very 
reign that the next material for the history of our medical 
progress is to be found. In that reign John Mirfeld, 
a Canon of the Priory, wrote a general treatise on medicine 
about the year 1380. The book is called ' Breviarium 
Bartholomei,' and as Mirfeld mentions cases which had 
occurred in his own observation there can be no doubt that 
he did not neglect the opportunities of the Hospital though 
the Priory was his proper home. The ' Breviarium Bar- 
tholomei ' shows what were the knowledge and practice 
of medicine in St. Bartholomew's when Richard II was 
king of England and William Wakeryng master of the 
Hospital. Several manuscript copies exist, of which I have 
examined three, but the handsomest copy of the book is 
that in the library of Pembroke College, Oxford. It is 
in Latin, and the date is indicated by a calendar for the 
year 1387, which is prefixed to it. It was written in the 
lifetime of Mirfeld, for a document of the year 1392 
shows that in that year he represented the Priory in a 
legal proceeding. 

The Pembroke manuscript is in its original binding 
and begins with an annotated calendar. 

The physician of the fourteenth century " was grounded 
in astronomye," and needed a calendar to calculate the 
effect of the heavenly bodies upon his remedies and upon 
his patients. 

" Wei cowde he fortunen the ascendent 
Of his ymages for his pacient." 

Mirfeld himself often refers to the calendar, as in his 
chapter on injuries of the head : " The astronomers say 
that if any one is wounded in the head when the moon 
is in the constellation of the Ram his wound is seldom 
or never cured, unless trifling." 

The ' Breviarium Bartholomei ' itself begins with a 
finely illuminated page. In the initial is a figure of St. 



9 

John the Baptist in his camel-hair garment bearing a lamb 
in his hand ; at the foot are the arms of the Benedictine 
Abbey of Abingdon. This Abbey had a Hospital at its 
gate dedicated to St. John the Baptist, of which this 
medical manuscript was no doubt once the property. It 
probably came to Bradgates Hall, now Pembroke College, 
soon after the dissolution of Abingdon Abbey. At the 
top of the page is written in red : — Here begins the 
book which is called Breviarium Bartholomei, composed 
by the venerable man, John Mirfeld, resident in the 
Monastery of Saint Bartholomew in London, from which 
that book is named. 

In the beginning, says the prefatory chapter, of this 
compilation, as in all our works, let us give thanks 
to God. Memory is slippery ; this makes it wise to 
collect what is known of medicine into a summary. And 
another reason for the book is that there are so many false 
physicians about who commit frauds upon the public. 

The book is spoken of as a compilation, and this is what 
all the medical books of that day are. Reading was 
thought more important than observation, and the main 
part of all their chapters is what they had read or heard, 
with only here and there scattered passages of what they 
had seen. 

The ' Breviarium ' is divided into fifteen parts : 
The first, is of fevers ; the second, of affections of the 
whole body ; the third, of affections of the head, neck, and 
throat ; the fourth, of the chest and its contents ; the fifth, 
of the abdomen ; the sixth, of the pelvic organs ; the 
seventh, of the legs ; the eighth, of boils ; the ninth, of 
wounds and bruises ; the tenth, of fractures and disloca- 
tions and twists of bones ; the eleventh, of dislocations of 
joints ; the twelfth, of simple medicines, the list of which 
is gone through in alphabetical order ; the thirteenth, of 
compound medicines ; the fourteenth, of purgatives, and 
the fifteenth, of the preservation and recovery of health. 

The plan is that of most of the medical books of the 
Middle Ages. The preface is always succeeded by an 



10 

elaborate treatise on fevers, based upon the classification 
of Galen. 

It is curious that in his section on the pestilential fever 
Mirfeld does not mention the Black Death, which had raged 
in England so near his time. He gives, however, a pre- 
scription, which was probably that used by the brethren of 
St. Bartholomew's in that dreadful epidemic, and which was 
told him by brother John Helme. It was a powder made 
of equal parts of aloes and eastern crocus, mixed and dis- 
solved in warm wine slightly sweetened. The chapter on 
pestilence ends with a prayer to be repeated in epidemics. 

Cattle plague is to be warded off by a method which 
may be forgiven for approaching magic, since it inculcates 
charity. Its substance is; — That cattle shall not die all the 
year through. On Christmas eve let three poor travellers 
be entertained, and beds made up for them of hay. And 
let that hay be placed daily between oxen till Twelfth day, 
and by the goodness of God they will be safe for the whole 
year, as is said. — Mixed up with the medicines recom- 
mended for the treatment of fevers are prayers for parti- 
cular occasions of the disease, and these are sometimes 
associated with practices taken from the prevalent folk 
lore. A little twig of hazel, a foot long, is to be broken 
in the middle. The two parts are to be held a little way 
apart and certain words repeated, and by virtue of the 
words the twig becomes united in some place. Here it is 
to be held by finger and thumb, and the rest cut away so 
that there is a little cross. This the feverish man is to 
hold above him, and to say some words in French, and 
five pater nosters, and he will be healed, as has often been 
proved, says the ' Breviarium.' 

Mirfeld had certainly witnessed the long wakefulness 
of typhus fever. That terrible vigil in which the patient 
lies upon his back, with his eyes wide open, hour after 
hour, drawing closer and closer to death. It may well 
make the physician mistrust his resources. There is no 
superstition in Mirfeld's prayer for this season of trial, 
for the quflint legend of the Christians of Ephesus, who 



11 

outslept the age of persecution, and on waking communi- 
cated the ways of the primitive Church to a later genera- 
tion, was received as undoubted history in his day. Stand- 
ing by such bedsides, Mirfeld said : 

" Oh Lord God ! Father Omnipotent, who showedst thy 
holy mercy on thy seven holy youths, Maximian, Malain, 
Dionysius, Marai, John, Constantine, and Serapion in the 
City of Ephesus, whom thou madest to sleep so long. So 
do by thy holy love to thy servant here, that he may rest 
with quiet sleep, and by sleep he may grow well, with 
soundness of body and of mind, to glorify and praise thy 
holy name, which is blessed, world without end. Amen." 

He was not afraid to bend over the patient in close 
attention to his wants, and recommends that the thickly- 
furred tongue shall be wiped with a linen rag, moistened 
in acid juice. 

If in doubt whether the patient be still alive his prac- 
tice was to put a little burnt lard to the nostrils. If alive, 
he says, the patient thereupon scratches his nose. 

In Part II skin diseases are described, and couplets 
are often given as aids to recollect their names and 
symptoms. 

Leprosy was then common in England. The palace 
which gives its diplomatic name to the court of England, 
was then St. James's Hospital for Lepers, and there were 
several other foundations for them in London. It is now 
so rare in London that few physicians have seen more 
than one or two cases. A few years ago a leper was for 
a long time in St. Bartholomew's. His face was dread- 
fully deformed by the thickening of the skin, and no one 
could have guessed that he was only twenty-one. He had 
acquired the disease in Asia Minor, where he was born, 
and long suffering had soured his disposition. His only 
friend was a Manx cat, which he brought in with him, 
and which, on going out, he begged the sister of the ward 
to treat kindly for his sake. Treatment did not at all 
improve his case, and he confirmed a remark which, 
Mirfeld says, Platearius, a learned doctor of Salernum, 



12 

made to a friend, " I confess that all kinds of leprosy are 
incurable." 

Mirfeld himself treated leprosy, he tells us, with some 
success with golden pills and a restricted diet. This 
included bread, two parts rye and one third barley, clear, 
well scented wine, game ratber than flesh of domestic 
animals, and eggs. Cheese, pulse, hares, salt meat, and 
putrefied food were to be avoided. 

The leprosy in one of his cases was relieved for three 
years, but after that appeared again. The virtues of 
sulphur water as a remedy for scabies were known to him. 

Ointment made from goose-fat is one of his chief 
remedies for gout, and these verses show how it is to be 
made. 

" Anser sumatur 

Veteranus qui videatur. 

Post deplumeter 

Intralibus evacuetur 

Intus ponatur 

Que subternus noroinatur 

Trita caro tota 

Catti mox pelle remota 

Mel sal f uligo 

Faba pondere jungitur equo 

Unctum porcinum 

Thus cera? sagmen ovinum. 

Post hoc assatum 

Tunc assus non commedatur 

Vas supponatur 

Sagmen ut accipiatur. 

Istud pinguamen 

Dat gutte cuique levamen. 

Auseris unguentum 

Valet hoc super omne talentum." 

The fat of the badger is also recommended, and this 
remedy is still believed in in the north of Ireland, where 
I once knew a farmer on Horn Head who had a quantity 
of badger fat which he used to rub on painful joints. 
Yew and ivy juice should be mixed in the ointment 
according to Mirfeld. 

Gout was, of course, common in London in Mirfeld's 



13 

time, and lie may have been consulted about a gouty nun 
of his time, the records of whose case I have read at 
St. Paul's. She was of the convent of St. Helen's, 
Bishopsgate, and the gout prevented her from attending 
services in her choir. Constancia the Prioress, and 
Margareta the Sub-prioress, locked her up and put her on 
low diet. She appealed to her ecclesiastical superiors, 
and at last the question was decided by Pope Urban VI 
in 1385. His brief finally settles the case, and orders that 
poor Joan Heyron, the nun of St. Helen's, afflicted with 
gout in her hands and feet, shall be released from her 
vows and allowed to go out of the convent, and shall 
receive a pension from it for the rest of her days. 

Mirfeld treated chronic rheumatism by rubbing the 
part with olive oil. This was to be prepared with 
ceremony. It was to be put into a clean vessel while the 
preparer made the sign of the cross and said the Lord's 
Prayer and an Ave Maria, and when the vessel was put 
to the fire the Psalm, "Why do the heathen rage" was 
to be said as far as the verse, " Desire of Me, and I shall 
give thee the heathen for thine inheritance." The Gloria, 
Pater Noster and Ave Maria are to be said, and the whole 
gone through seven times. " Which done let that oil be 
kept." 

The mixture of prayers with pharmacy seems odd to 
us, but let it be remembered that Mirfeld wrote in a 
religious house, that clocks were scarce, and that in that 
age and place, time might not inappropriately be measured 
by the minutes required for the repetition of so many 
verses of Scripture or so many prayers. The time 
occupied I have tried, and found to be a quarter of an 
hour. 

Mirfeld gives a well-sounding definition of dropsy. 
" It is a failure of the digestive power in the liver causing 
distension of the limbs," but neither he nor any other 
medical writer had any real knowledge about the subject 
till after Lower, in 1669, showed that dropsy followed the 
obstruction of the veins of a limb. 



14 

One of Mirfeld's methods of treatment was a bath of 
willow leaves. 

He has many remedies for jaundice, and mentions in 
his account of them that he had studied at Oxford where 
Master Nicholas Tyngewich narrated from his professional 
chair how he had heard of an old woman who cured 
jauudice. He rode forty miles to see her and gave her a 
sum of money for knowledge of that cure. Here is the 
cure. 

" Take an apple and let it be divided into four parts. 
On the first part write + In nomine patris + ihesus + and 
give to the patient to eat, and if not thus cured write on 
the second part + et filii + nazarenus + and in the third 
part write + spiritus sancti + Amen. + rex judeorum + 
crux Cristi 4- Amen + and the first part must beforehand 
have been hidden where no man could find it." 

It is curious to note that nearly three hundred years 
later this method of cure is mentioned as being used by 
quacks and popular in London. 

Mirfeld often mentions English names, both of remedies 
and of diseases, and speaks of variola as " smal pockes." 

If the treatment of scrofula is not successful " we go 
to the king, because by touch alone kings are wont to 
cure that infirmity." 

Mirfeld condemns inebriety on hygienic grounds, but 
does not omit further reflections on the subject. "Drunken- 
ness is called the mother of all vices and faults ; it is 
the actual root of crimes and the origin of vices. There- 
fore by every Christian it is to be sedulously avoided." 

All through the book the curious mediasval readiness 
to accept any explanation of a result is apparent. 

The hearts of animals are not to be eaten because they 
cause forgetfulness. Thus some widows of Salernum 
who wept for their husbands made pasties of the hearts 
of sucking-pigs, with seasoning, and after eating the 
pasties forgot all about their sorrows. " Perhaps, how- 
ever," adds Mirfeld, without a smile, " the hearts of 
animals are not to be eaten because they are indigestible." 



15 

Part III goes on to diseases of the head and neck and 
throat. 

A mouse's head in a little bag hung by a string round 
the neck will keep off headache. 

Verses repeated in the ear are to be tried to rouse the 
epileptic man as he lies on the ground. The epileptic 
unconsciousness lasts, as has been shown by modern 
students of the disease, a much shorter time by the watch 
than it seems to a horrified onlooker, and no doubt, as 
Mirfeld and other writers of his time assert, the patient 
often got up after — 

" Gaspar fert mirram : thus Melchior : Balthazar 
aurum. 
Hec tria qui secum portabit nomina regum, 
Solvitur a morbo Domini pietate caduco " 

was repeated in his ea.r. 

To a man ignorant of the fact that while the condition 
which produces an epileptic fit is a temporary disturbance, 
that causing an apoplectic fit is one involving actual 
destruction of a part of the brain, it must have seemed 
reasonable by analogy that verses should do good to an 
apoplectic patient. 

Mirfeld recommends an empiric remedy of English 
Gilbert. The following two verses are to be tied round the 
arm, the Lord's Prayer being said the while. The verses 
are to be written with crosses above and below each 
word : 



+ 


+ 


+ 


amara 


timi 


taturi 


+ 


+ 


+ 


postos 


sigaloa 


sicalui 


+ 


+ 


+ 


Ely 


poly 


carras 


+ 


+ 


+ 


polyly 


pylini 


lyvarn 


+ 


+ 


+ 



This must be admitted to be a charm pure and simple. 



16 

Toothache was treated by putting a little brandy in 
the hollow tooth. 

Mirfeld nowhere tells us who taught him, but speaks 
every now and then of " my master." He was once 
called to a woman who had lost her speech. He rubbed 
her palate with theodoricon emperisticon and with a 
little diacastorium. She recovered her speech, and bore 
witness to his skill. 

Some of his master's cases are related at great length. 
" An apothecary brought him a youth with a carbuncle on 
his face. His whole neck and throat were swelled beyond 
belief, and the sick man had already tokens of death ; he 
had no pulse and was fainting. My master said to that 
apothecary that the youth should go home for he was 
about to die in a short time. The apothecary said, ( Is 
there no further remedy ? ' The physician replied, ' I 
believe most truly that if thou mightest give tyriacum 
in a large dose there is a chance that he may live.' 
Having heard this the apothecary took him home, and 
was barely able to get there, and he gave to him about 
two drachms of tyriacum and put him to bed. His 
head and the affected part broke into profuse perspira- 
tion, and after a little there was a general perspiration, 
and his pulse returned. And the apothecary gave him 
the dose again of his own accord, and that day he was 
made whole except for a little sore place which afterwards 
healed up, and my master said that he had never seen 
anyone else who had recovered after being in a faint and 
tremor and especially without pulse." 

This account shows that Mirfeld's master was a regular 
physician, and that, like Chaucer's physician, 

" Ful redy hadde he hia apotecaries 

To sende him dragges and his letuaries." 

After observing truly enough that an injury on the 
right side of the head is likely to lead to paralysis on the 
left, he relates the case of one of the Canons of St. Bar- 
tholomew's, who was treated by his master. The Canon 



17 

was about to get on his horse, and when the said Canon 
>,ished to seat himself in the saddle that horse arose on 
his two hind legs, and the Canon fell head downwards 
over the crupper of the horse to earth. And fell so 
heavily upon his head that straightway he lost the sensa- 
tion and movement of his whole body. My master 
having been called by the friends of the patient, made 
them shave his head, and then rubbed in oil of roses with 
a quart of warm vinegar, and sprinkled it with a powder, 
and put over it a fine cloth soaked in the aforesaid oil 
and vinegar, and over that fastened linen stoups and 
bound with bandages his whole head, and put over all 
the skin of a lamb. And every day he visited him twice, 
and rubbed in ointment into his neck and as far as the 
middle of his spine. On the second day the patient 
opened his mouth a little. Then one of his friends 
wished to try if he would eat, but the physician would 
not allow it, and said, " Even if he wished to eat I would 
not let him." On the third day, when a question was put 
to him, he tried to answer, stammering, but he could not 
form the word. On the fourth day he spoke stammeringly, 
and then they handed him a thin warm drink, which he 
saw and swallowed. The fifth day he took a thin tisane. 
On the sixth day they gave him chicken broth. He 
then began to grow stronger, little by little, and to be 
able to move, but it was many days before he could 
walk. When he was able to take food my master began 
to prepare pills, to resolve by evacuation the residue of 
the material accumulated by the fall on his head. He 
recommended that he should eat the brains of birds and 
fowls and kids, and thus doing he was cured. But the 
poor Canon was never quite the same man again, as Mir- 
feld says : " Nunquam tamen fuit ita subtilis ingenii et 
bone memorie sicut prius." 

His master was a bold operator. My master, he says, 
thus operated in a case that came under his hands of the 
daughter of a friend of his with water accumulated in the 
head. This is what he did. First rubbed in sulphur 

2 



18 

ointment twice a day, keeping a cloth of warm wool on 
the head ; then he tapped the head by the cautery in 
front. Water came out slowly. After a time he made a 
similar hole in the back of the head and more water came 
out, and in less than a year the patient was quite well. 

On another occasion his master was called to a man in 
prison, who in desperation stabbed himself, so that when 
he swallowed, food and drink and air came out of the 
wound. My master, says Mirfeld, joined the parts of the 
wound decently, and covered the place with powders and 
bandages, so that the man was cured within a month and 
lived. 

Now and then a remedy, still considered efficacious, is 
mentioned, as where the ' Breviarium,' quoting Avicenna, 
recommends turpentine for chronic bronchitis. 

An electuary which King Carolus used to use is recom- 
mended for stomach-ache, but whether this was King 
Charles of Naples, who lived in 1350, or King Charles II 
of Sicily, who died in 1300, or King Charles of Navarre, 
or the great Karl himself, we are not told. 

Several remedies rest upon the dicta of visions. A 
holy man in a dream told a woman of Sicily that plantago 
was good for enlarged lymphatic glands, and Galen him- 
self appeared to a certain monk and recommended colo- 
cynth for gout, with an external application of bdellium, 
cabbages, and marjoram, and assured the monk that the 
cure would be complete in three days. A remedy for oxen 
was mentioned, and further on are medicines for horses. 

When he gets to injuries, Mirfeld regrets that medi- 
cine and surgery have become separate lines of practice. 

Long ago, unless I mistake, he says, physicians used to 
practise surgery, but now-a-days there is a great difference 
and distinction between surgery and medicine ; and this I 
fear arises from pride, because physicians disdain to work 
with their hands, though, indeed, I myself have a suspicion 
that it is because they do not know how to perform par- 
ticular operations, and this unfortunate usage has led the 
public at large to believe that one man cannot know both 



19 

subjects ; but the well-infoimed are aware that he cannot 
be a good physician who neglects every part of surgery, 
and on the other hand a surgeon is good for nothing who 
is without knowledge of medicine. 

In the part on fractures Mirfeld is not afraid to time 
with precision the recovery of each broken bone. A rib 
will take twenty days. A humerus or a thigh bone forty 
days. He had noticed that union is more difficult in the 
aged. Dislocations were reduced with an instrument, 
" quod vocatur tornellus anglice wyndas." 

The book on simple medicines recommends the diamond, 
a stone born in India, for keeping off evil visions, for the 
diamond is hostile to the devil. 

Mirfeld had not tried all the experiments in chemistry 
which he describes. A diamond, he says, sprinkled with 
goat's blood can be cut with a leaden saw into as many 
parts as you please. 

The ' Breviarium ' recommends nuts as a remedy against 
poison, among others those in English called " Wallheno- 
ton." 

Opium, he says, is of two kinds, but the second proves 
to be really asafcetida. He tells a story of a trick upon 
travellers played with opium. A bad host used to give 
opium to travellers' horses. When a horse fell down as if 
dead he used to offer money for the skin, and when the 
travellers were on their way he would take vinegar, open 
the horse's mouth, and pour it in, and the horse would 
soon get up. Thus are travellers deceived. 

The frauds of apothecaries are mentioned ; they used to 
substitute the cartilage of a goat's heart for the bone 
found in a stag's heart. 

A little blessed water out of a font will stop frogs 
croaking in the moat. 

Many fully made-up prescriptions are given. How to 
make gruel and how to make gingerbread are told. 
G-ruellus anglicorum is made of coarse oatmeal with 
the husk off, and gingerbread, which is really toffee, of 
honey and ginger baked together. The receipt is : 



20 

Take a quart and a half of refined honey and half an 
ounce of Cyprus ginger, and mix them and heat gently. 
If the mixture is enough cooked it will grow black. If 
not enough you can tell by putting a knife in it and 
cooling it in the air. If then the bit cooled on the knife 
is brittle in the mouth, it is done enough. Then take it 
off the fire and add powder of ginger. 

He glories in pills with great names : The pills of the 
King of Sicily, the Parisian pills, the pills of the glorious 
King Richard, the pills of the King of England. 

His powders are equally grand ; the powder of Al- 
mansor, the powder of Patrick of Ireland, the powder of 
John Gaddesden, the dormitorium of Mr. John Wyke. 

One preparation which he mentions may justly be re- 
garded as the earliest preparation of our Hospital Pharma- 
copoeia — it must be looked upon as the ancestor of the 
plaster seen in the Surgery every day with " St. B. H." 
stamped upon it, for Mirfeld calls it " Emplastrum Bar- 
tholomew" This plaster is good for all wounds, whether 
of the head or body, also for cancers and fistulas : 

The receipt is : Take juice of the parsley and of the 
plantain and boil them, and when the liquid begins to boil 
add some fine wheat flour, and boil over a slow fire till 
thick. Add an equal quantity of honey and thicken 
at will. 

If you carry a stick of agnus castus on your travels, 
says Mirfeld, your feet will not get sore. Perhaps this 
belief is a reason why the ladies in the Flower and the 
Leaf are described as adorned with it, 

M And wreaths of agnus castas others bore." 

for these ladies of the leaf do not suffer fatigue and relieve 
the damsels of the flower who do. 

Another preventive of fatigue proposed in the ' Brevi- 
arium ' is to carry a badger's foot with you. 

The chapter on keeping health, which ends the book, is 
based upon the most famous medical book of Salernum 
the ' Regimen Sanitatis Salerni.' It is followed by an 



21 

elaborate table of contents, with the help of which it is 
easy to find anything in the MS. 

The picture is complete of the medical and surgical 
practice in St. Bartholomew's Hospital in the reign of 
Richard II. 

Such was fourteenth century practice ; what were the 
authors consulted in that age ? They are described in 
some lines of Chaucer's ' Prologue :' 

" Wei knew lie the olde Esculapius, 
And Deiscorides and eek Enfus, 
Old Ypocras Haly and Galien, 
Serapyon, Razis, and Av\cen, 
Averrois, Damascien, and Cuiistantyn, 
Bernard and Gatesden and Gilbertin." 

With the exception of ^Esculapius, for whose works 
Chaucer drew on his imagination, these are all physicians 
whose books are to be found in the library of the College 
of Physicians. They were constantly quoted in every 
medical treatise of the Middle Ages. It is quite safe to 
say that you would not be able to open any work of the 
Middle Ages without finding six of these authors at least 
on the page. Such was the state of medicine five hundred 
years ago, in the reign of Richard II. The physicians of 
that time read these books, and believed everything they 
contained, and when they wrote a fresh book they put 
down again what they had read. They were perfectly 
ready, without the slightest idea that they were not 
telling the exact truth, to state such facts as that you 
could saw a diamond under certain circumstances with a 
leaden saw. Such were the ways of thought of the physi- 
cians of those centuries — and no one seems to have risen 
above them. The revival of learning at last came, and an 
event took place in the neighbourhood of this Hospital, 
which was to completely alter the state of medicine in 
England. This was the foundation of the College of 
Physicians. Its first residence was in Knight Rider Street, 
in the neighbourhood of St. Paul's Cathedral. Soon after 



22 

it moved to Anien Corner, and in 1669 to Warwick Lane, 
and there remained until, in the reign of George IV, it 
moved to its present site in Pall Mall East. It was founded 
by Thomas Linacre, and he, with five others, formed the 
original College. They differed in their idea of medicine 
from Mirfeld. Mirfeld saw clearly that you were to do 
what you could for your patient, and that was Linacre's 
aim too, but they proposed to get at it in totally different 
ways. Mirfeld believed in the ancients as far as he 
knew them. Linacre and his College got beyond this ; 
they believed they could add much to the knowledge of 
the ancients, and though they believed what Hippocrates 
and Galen said was true, they did not hold it to be the 
whole truth, they believed that a great deal remained to 
be found out. That idea had not occurred to Mirfeld ; 
he thought the whole system of medicine was already 
known. The College of Physicians was founded in 1518 
by Linacre, who lived in our immediate neighbourhood, 
and was buried in St. Paul's, and nearly every physician 
to St. Bartholomew's since 1518 has been a Fellow of that 
college. 

The first regular physician here was Dr. Roderigo Lopus. 
I might proceed to tell you something about all the physi- 
cians who have succeeded him, of whom I have before me a 
list. It would be a most interesting way of spending the 
evening to mention something about each of them, but I 
do not propose to follow it, for I wish to put before you 
not our whole history, but only the chief steps of our 
medical progress. 

I may, however, mention a few of the physicians : — Dr. 
Bright (not the person after whom the disease of the kidneys 
is called, for that great discoverer was a physician at Guy's 
Hospital) wrote rather an amusing treatise on melancholy, 
and was the inventor of shorthand, the first man to whom 
the idea occurred of taking down what was said by a series 
of signs. He was followed by Dr. Doyley, still remembered 
as a Spanish scholar, and he by Dr. Wilkinson, of Trinity 
College, Cambridge. Then next to him came Dr. William 



23 



Harvey. Then another one, a little way on, is Dr. Francis 
Bernard, whom, I think, we ought always to remember, 
for when apothecary to this Hospital he stayed in London, 
in this Hospital, throughout the plague. He afterwards 
became a physician, and I have no doubt, because of his 
devotion, was elected, on a vacancy, physician to the Hos- 
pital. And so I might go on. I think you may be a little 
surprised to learn how few physicians there have been on 
the staff of this Hospital — including the present ones, 
there have only been forty-nine. 

Here are their names and dates of appointment. All 
but four (Torner, Bright, Pate, Biddulph) were Fellows of 
the College of Physiciaus. 

Dr. Lopus 

Dr. Tomer 

Dr. Timothy Bright 

Dr. Thomas Dm ley . 

Dr. Ralph Wilkinson 

Dr. William Harvey 

Dr. Clarke 

Sir John Mieklethwaite 

Dr. Christopher Teartie 

Dr. Arthur Dacres . 

Dr. Francis Bernard 

Dr. Edward Browne . 

Dr. Robert Pitt 

Dr. Henry Levett . 

Dr. Salisbury Cade . 

Dr. William Wagstaffe 

Dr. Richard Tyson . 

Dr. Pierce Dod 

Dr. Win, Pitcairn 

Dr. Win. Barrowby (3rd) . 1750 

Dr. Robert Pate 

Dr. Anthony Askew . 

Dr. Richard Tyson . 

Dr. John Lewis Petit 

Dr. David Pitcairn . . 1780 

The next physician I shall mention was a resident in 
our Hospital but not a member of its staff. This is Dr. 
John Caius, a name illustrious in the University of Cam- 





Dr. 


Richard Budd . 


1780 


1580 


Dr. 


John Gideon Caulet . 


1784 


1586 


Dr. 


William Austin . 


1786 


1590 


Dr. 


John Latham 


1793 


1602 


Dr. 


Francis Biddulph 


1793 


1609 


Dr. 


Edward Roberts 


1794 


1634 


Dr. 


Richard Powell . 


1801 


1643 


Dr. 


James Haworth . 


1802 


1653 


Dr. 


Clement Hue 


1823 


1669 


Dr. 


Peter Mere Latham . 


1824 


1678 


Dr. 


George Leith Roupell. 


1834 


1682 


Sir 


George Burrows, Bart. 


1841 


1697 


Dr. 


Fred. John Farre(4th) 


1854 


1707 


Dr. 


Henry Jeaffreson 


1854 


1708 


Dr. 


Patrick Black . 


1860 


1720 


Dr. 


Wm. Senhouse Kirkes 


1864 


1725 


Dr. 


Martin 


1865 


1725 


Dr. 


George Nelson Edwards 1867 


1749 


Dr. 


Francis Harris . 


1868 


1750 


Dr. 


Andrew 


1869 


1752 


Dr. 


Reginald Southey 


1870 


1754 


Dr. 


Church 


1874 


1762 


Dr. 


Gee . 


1878 


1774 


Sir 


Dyce Duckworth 


1883 



24 

bridge, and not less illustrious in the College of Physi- 
cians. He occupied a house within the Hospital at the 
annual rent of £4 a year. During Dr. John Caius' 
lifetime occurred one of the epidemics of what was called 
the sweating sickness, a curious febrile disorder first 
noticed in the reign of Edward IV, and frequently after- 
wards. Dr. Caius wrote a treatise on it, which may be 
called the first original treatise on medicine published 
in England, by which I mean the first treatise in which 
the modern idea of observing the disease and writing a 
complete account of what was actually seen was carried 
out. He was thoroughly versed in the expressions of 
Galen and Hippocrates, and of course to us many of his 
hypotheses seem extremely improbable, but his observa- 
tions are also deserving of respect. 

" This disease is not a Sweat onely, (as it is thought & 
called) but a feuer, as I saied, in the spirites by putrefac- 
tion venomous, with a fight, trauaile, and laboure of 
nature againste the infection receyued in the spirites, 
whervpon by chaunce foloweth a Sweate, or issueth an 
humour compelled by nature, as also chanceth in other 
sicknesses whiche consiste in humours, when they be in 
their state, and at the worste in certein dayes iudicial, 
aswel by vomites, bledinges, & fluxes, as by sweates. 
That this is true, the self sweates do shewe. For as in 
vtter busineses, bodies y' sore do labour, by trauail of 
the same are forced to sweat, so in inner diseases, the 
bodies traueiled & labored by the, are moued to the like. 
In which labors, if nature be strog & able to thrust out 
the poiso by sweat (not otherwise letted) y c perso 
escapeth : if not, it dieth. That it is a feuer, thus I 
haue partly declared, and more wil streight by the notes 
of the disease, vnder one shewing also by the same notes, 
signes, and short tariance of the same, that it consisteth 
in the spirites. First by the peine in the backe, or 
shoulder, peine in the extreme partes, as arme or legge, 
with a flusshing, or wind, as it semeth to certeine of the 
pacients, flieng in the same. Secondly by the grief 



25 

in the liuer and the nigh stomacke. Thirdely, by the 
peine in the head, and madnes of the same. Fourthly by 
the passion of the hart. For the flusshing or wynde 
commiug in the vtter and extreame partes, is nothing els 
but the spirites of those same gathered together, at the 
first entring of the euell aire, agaynste the infection 
therof, & flyeing thesame from place to place, for their 
owne sauegarde. But at the last infected, they make a 
grief where thei be forced, whiche comonly is in tharme 
or legge (the fartheste partes of theire refuge) the backe 
or shulder : trieng ther first a brut as good souldiers, 
before they wil let their enemye come further into theire 
dominion. The other grefes be therefore in thother partes 
aforsaid & sorer, because the spirites be there most 
pletuous as in their founteines, whether alwaies thinfection 
desireth to go. For fro the liuer, the nigh stomack, 
braine, and harte, come all the iij. sortes, and kyndes of 
spirites, the gouernoures of oure bodies, as firste spronge 
there. But from the heart, the liuish spirites. In 
putrifieng wherof by the euel aier in bodies fit for it, the 
harte is oppressed. Wherupon also foloweth a marueilous 
heauinesse, (the fifthe token of this disease,) and a desire 
to sleape, neuer contented, the senses in al partes beynge 
as they were bounde or closed vp, the partes therfore left 
heuy, vnliuishe, and dulle. Laste foloweth the shorte 
abidinge, a certeine Token of the disease to be in the 
spirites, as wel may be proued by the Ephemera that 
Galen writethe of, whiche because it consistethe in the 
Spirites, lasteth but one natural day. For as fire in 
hardes or straw, is sone in flambe & soue oute, euen so 
heate in the spirites, either by simple distemperature, or 
by infection and putrefaction therein conceyued, is sone 
in flambe and sone out, and soner for the vehemencye or 
greatnes of the same, whiche without lingering, consumeth 
sone the light matter, contrary to al other diseases 
restyng in humoures, wherin a fire ones kindeled, is not 
so sone put out, no more then is the same in moiste 
woode, or fat Sea coles, as well by the particular Example 



26 

of the pestilence, (of al others most lyke vuto this) may 
be declared, whyche by that it stadeth in euel humors, 
tarieth as I said, sometyme, from iiij. vii. ix. & xj. vntill 
xiiij. dayes, differentlie from this, by reason therof, albeit 
by infection most lyke to this same. This vnder one 
laboure sbortelie I haue declared — both what this disease 
is, wherein it consisteth, howe and with what accidentes 
it grieueth and is differente from the Pestilence, and the 
propre signes, and tokens of the same, without the whiche, 
if any do sweate, I take theym not to Sweate by this 
Sickenesse, but rather by feare, heate of the yeare, many 
clothes, greate exercise, affection, excesse in diete, or at 
the worst, by a smal cause of infection, and lesse disposi- 
tion of the bodi to this sicknes. So that, insomoche as 
the body was nat al voide of matter, sweate it did when 
infection came : but in that the mattere was not greate, 
the same coulde neyther be perilous nor paineful as in 
others, in whom was greater cause." 

You see he has tried to describe what he observed, and 
if you separate it from the phraseology of his time — which 
did not in any way spoil his observation — he has clearly 
told from personal observation the onset and progress of 
the disease. He says it is true it is rather like the 
syrocbus of Galen, but all the same gives a clear descrip- 
tion from what he had himself seen. It was in all pro- 
bability a violent kind of influenza. Now, Dr. Caius 
was a most learned man, and he believed that in Galen 
much truth was to be found. He believed that what the 
ancients said was true and of authority, but he also 
believed that there was a great mass of medicine to be 
found out by observing patients and by describing their 
symptoms, and by examining their bodies after death, 
and he entirely rejected all the compiling authors of the 
middle ages. He and the physicians of the College 
thought that Hippocrates and Galen were always right, 
but that much was to be learned from our own individual 
observation, and they approached the belief that more was 
to be learned at the bedside than in the library. This was 



27 

a great advance. Dr. Caius continued to live in St. 
Bartholomew's Hospital for many years. The first dinner 
— the first banquet of the College of Physicians — was held 
at this Hospital in Dr. Caius' house in 1554. At the 
present day, when the President of the College of Physi- 
cians takes the chair at the comitia majora of the College, 
a meeting which consists of the President and all the 
Fellows, he bears in his hands, as a sign that the meeting 
has begun, a silver sceptre, on the top of which are 
four little serpents. This sceptre was made at the 
expense of Dr. Caius, and after it was made the College 
had this dinner at Dr. Caius' house in this Hospital. 
Dr. Caius died in 1573. Shortly before the year 1609 
Dr. William Harvey came to this Hospital from Cambridge. 
Harvey was a physician of the same kind as Caius, and I 
think we ought to remember low very much Caius did 
towards encouraging the study which led to the great 
discovery of the circulation of the blood by Harvey. 
Caius left money so that there should always be dissec- 
tion of the human body, the actual study of anatomy 
going on at the College of Physicians and at Cambridge, 
and it was that opportunity of knowledge while at the 
University that made Harvey such a proficient in anatomy 
as he actually was. So it was Dr. Caius who was the 
means of leading Harvey to his discovery. 

Harvey gave in 1616 the lectures at the College of Phy- 
sicians in which the circulation of the blood was first 
announced. It is worth considering well what kind of a 
physician Harvey was, for he is certainly by far the most 
illustrious person who has been on the staff of this Hos- 
pital, and the one who has done most to further the 
progress of medicine. 

What stage had he reached in the course of medical 
progress ? If you look at the biographies of Harvey — many 
of them are careless — you see it stated that it is doubtful 
whether he was a great physician in his own time. There 
is no ground for this assertion : he certainly was a great 
physician — his object in life was the treatment of patients ; 



28 

literature as well as science interested him ; but his whole 
wish and desire was to learn to cure disease, and the 
statement that Harvey was not thought distinguished in 
his profession in his own time can be traced to a remark 
of a non-medical writer of the period, Mr. Aubrey, who 
wrote a gossiping volume of personal recollections. 

If you look into Harvey's works, his lectures on 
anatomy and his book on the circulation of the blood, 
you will find that he was first of all, and all through his 
life, a physician anxious to cure patients. Like Linacre 
and Caius he had great respect for the ancients. He 
thought Galen worth careful study. A few weeks ago I 
had to go to the British Museum for something else, and 
happening to take out a copy of Galen noticed that it had 
upon it notes by Harvey, undoubtedly in Harvey's hand- 
writing. Now, Harvey had a habit, when he wrote down 
what he thought original, of putting his own initials, 
" W. H.," against it. In this Galen, Harvey has thus 
placed his initials after several manuscript notes. He 
had studied Galen carefully, and all these treatises are 
carefully annotated throughout in his handwriting. It 
would not have needed this, however, to assure us he was 
deeply versed in ancient medicine, for in his lectures he 
often refers to all the old authors. He had thought 
deeply over Aristotle ; and in one lecture he says that it 
was a passage of Aristotle which first suggested to him 
the idea of the circulation of the blood. 

The medical authors so often quoted by Mirfeld are 
never mentioned by Harvey. Taking Harvey's lectures 
on anatomy — of which the manuscript was published in 
1886 — much may be learnt of his medical attainments. 
They do not read continuously, they are the actual notes 
of his lectures, written largely in Latin, and partly in 
English. He was lecturing on anatomy, so he only used 
medicine as an illustration ; and no doubt what he ac- 
tually said was much more full than what is left in 
writing. To take his account of the liver as an example ; 
he describes ten conditions which are all now well known 



29 

to us. He does not explain their pathology, but by de- 
scribing them he made the first step in the direction of 
explanation, and his remarks on the liver are a fair example 
of how rich in observation his notes are. It is worth 
while to interpret his quaint expressions. 

(1) " Item russetish Ingentem et durum plane scirrus 
tumor absque pene sanguine aspera superficie." 

This russet-coloured, large, hard, scirrhus-like, bloodless 
liver with a rough surface, we should call a case of cir- 
rhosis. 

(2) " Between russet and purple as big as an ox liver 
Jhon Bracey extentum," was probably an amyloid liver. 

(3) " Begining to be discolored Joan Johnson mortua 
ex febre maligna," was the swollen liver of raised tem- 
perature. 

(4) " Palish dirty color cum mucca on ye coat. 
Hydrope resudante materia little blathers or tanquam 
blisters," is the liver of general peritonitis. 

(5) " Like a heap of pus colore subfavescum noe shape 
nor particle remayninge Jecoris," was probably a large 
abscess of the liver. 

(6) " Ut plurimum ubi in Hydrope vel alias ubi Jecur 
russetish splen watchet greenish or lead color si morbo 
ex cachexia," describes the thickening of the capsule 
often found after death with chronic peritonitis. 

(7) "Apostema ingens per multos menses ex pure 
fcetidissimo 2 or 3 gallons et aqua cum viscosit panni- 
culis convolutis as glew stepened in water or Isonglass : 
regressum Hospitali." 

The little sticky rags like glue or isinglass and the 
large quantity of fluid show clearly that he is describing 
a great hydatid cyst filled with fluid and daughter cysts. 

(8) " Mortua Inflammatio Jecoris of a botch in tunica 
red 

hard 
cancerous." 

This botch was a mass of new growth. 

(9) " Absessulaa ut cuniculis." 



30 

This was probably a liver of pyaemia with many small 
abscesses. 

(10) " Extenuato cum felle magis disfcentum ut urina 
et calculis referto ab ictero." 

This liver distended with thin watery bile and with 
gall-stones was of the form of cirrhosis due to long- 
continued obstruction of the common duct. 

These are ten distinct and most important observations 
on the condition of the liver. If you compare these 
observations of his with any earlier works you will see 
that Harvey really belonged to our time, and that in 
his opinion you are to learn how diseases are produced 
not only by poring over books but by examining the 
body after death, and comparing the anatomical appear- 
ances with the symptoms observed during life. 

The physician to St. Bartholomew's in Harvey's time, 
learned and valuable as he was, did not do all the work of 
the Hospital ; on the contrary, a great part of the laborious 
work of the Hospital was done by a man who was not 
thought distinguished enough to come as a guest to the 
dinner at Dr. Caius' house, though they had him in after 
dinner to warn him what he must not do, and that man was 
the surgeon. He was a member of a company in the City of 
London which for a long time had a hard struggle to live 
among the companies, and he practised an honest occupa- 
tion and hoped always " to hold himself as a good artist." 
But he was in a very subordinate position in the Hospital, 
and had very few opportunities of improving himself with 
the learned persons of his time ; and the next step I wish 
to point out to you is how the surgeon came to improve 
himself. He was not even allowed to see the prescrip- 
tions, for they were carefully locked up. He nevertheless 
took to observing — observation of patients had been set 
before mankind as the way to find out about disease. 
The surgeons took earnestly to observing. The physicians 
for several centuries had been reading, and then came to 
observing at St. Bartholomew's, but you will notice that 
the surgeons had read very little, and began to observe 



31 

before they had read much. Of course, they knew how 
to read, but were not learned book men. At last the 
time came when there appeared a really learned surgeon, 
a surgeon who had not only observed but read. That 
surgeon was Charles Bernard, who worked here from 
1686 to 1710. He was surgeon to Queen Anne, and 
had one of the finest libraries of his time. The College 
of Physicians possess some of his books, and in one of 
the books now in the library there is written his name, 
Caroli Bernard : Chir : Lond : in his own handwriting. 
He was not only well read but was one of the best 
observers of his profession. I believe it is to him we 
owe first the observation that new growths are likely to 
recur, and this ought to be remembered in connection 
with his name. He was a person of extraordinary learning 
and pleasant conversation, and Swift mentions his death 
with regret. He was the scientific ancestor of the learned 
surgeons who since his time have continued to flourish 
here — Pott, Abernethy, Lawrence, with those no less dis- 
tinguished ones who flourish at the present day, and 
whose names are so well known to you. 

From Bernard's time there ceased to be any great 
difference in culture and distinction between the members 
of the Staff, and in that very period, in the time of 
Charles Bernard, an observation was made here by a 
frequenter of the Hospital, a person buried in St. 
Andrew's, Holborn, of whom we have all heard, though 
when I tried to learn exactly who he was from several 
anatomists, I could not learn from them his Christian 
name, when he lived, or anything about him. This 
person was Douglas, after whom the fold of Douglas 
is called. Douglas was a physician in London, and he 
constantly attended this Hospital, and went round the 
wards. In ] 716 he describes very clearly in a paper 
in the ' Philosophical Transactions,' the general appear- 
ances of amyloid disease of the spleen, but not, of course, 
the appearance produced by adding iodine, in a case of 
marasmus with strumous enlargement of the lymphatics. 



32 

This was not a very thorough discovery ; but another 
thing he made out is very much more remarkable. He 
says that while he was going round the Hospital of St. 
Bartholomew he saw a young man suffering from palpita- 
tion, and that as his heart beat he could hear a distinct 
sound with the beating of his heart. The man died and 
Douglas describes how at the post-mortem he saw the 
heart was enormously enlarged, and the aortic valves 
were contracted and hard so as to allow the blood to 
flow back into the ventricle. He had thus discovered 
the murmur caused by aortic disease a hundred years 
before the stethoscope came to make such observation 
easy. This, then, was a great step in medicine actually 
made in the wards of this Hospital. Another step made 
a little later in the century ought always to be remembered 
here, although it may seem slight now-a-days, and that is 
Dr. David Pitcairn's discovery that inflammation of the 
valves of the heart is common in rheumatic fever. 

I have tried to give you some information of what the 
progress of medicine has been in St. Bartholomew's, — of 
a few of its important steps. I have shown you what were 
the medical ideas when the Hospital began : you know 
yourselves what our present state of knowledge is. I have, 
of course, not described every improvement which has 
taken place but have only pointed out some of the more 
important steps which have led to our present condition. 
I have described how the physician grew from a school- 
man into a scientific observer, and how the surgeon ap- 
peared on the scene in livery and without learning and 
grew from a handicraftsman to be a man of science. 

Two other actors in this history remain to be mentioned. 
First of all the actual student of medicine, a person to 
whom, I believe that, in our own time, the progress of 
medicine is enormously due. You will remember that Dr. 
Thomas Young, who was the originator of the undula- 
tory theory of light, made one of his discoveries while a 
student here, before he was twenty years of age, and 
that he was elected a Fellow of the Royal Society while 



33 

a student here. Another student — a member of this 
Society — discovered trichina spiralis in muscles. He is 
now well known to all the world as Sir James Paget. 

But these were great and exceptional students, and 
when I spoke of the value of students to the advancement 
of medicine I was thinking rather of the influence which 
all students exercise on their teachers, the physician and 
the surgeon. 

The students' criticism must always make observation 
so much more careful, and statement so much more 
measured than if they were absent, that their presence is 
invaluable to the patients as well as to the physicians and 
surgeons. I believe it is largely to this influence that 
the great progress of medical observation in recent times 
has been due. You will see in our calendar a short 
preface, relating how students began here soon after 1660, 
but it is incomplete and does not carry the record far 
enough back. Harvey himself studied here early in the 
reign of James I, and it was the custom of men who 
wished to study medicine to go into the wards and pick up 
a little, though not to work systematically as they do now. 

There is one other class of persons who have been added 
to our medical life, and who are an important addition 
to our means of treating patients. These, of course, are 
the nurses. When Dr. Caius lived here there was in 
every ward, as at the present day, a sister, but her chief 
business was to maintain order, and to see that the 
patients spun the proper amount of flax, and to take care 
that the yarn delivered to her bore a just proportion to 
the thread that went out. From that to our present 
elaborate system of nursing is a great change. The pro- 
gress in this direction has been very rapid in the last 
few years, and it has now reached the conclusion, which 
one would have thought it would have reached before, 
that careful education and training produce more useful 
nurses than chance. The result is that the directions 
of the physicians and surgeons are carried out in a way 
which was unknown before. 

3 



34 

I have tried to show you how the Hospital began to 
treat patients. First of all we had men like Mirfeld, who 
looked into old treatises and compiled new ones, rearrang- 
ing old information, and never correcting it by systematic 
observation ; who sometimes made a sensible remark but 
never added to knowledge. Then came men like Dr. 
Caius and Harvey, who believed in ancient learning, but 
made original observations and looked to observation as 
the means of advancing medicine, so that from their day 
discoveries have continuously been made here. Thus the 
patient, with whom we began as the foundation of all, has 
led to the creation of the physician, of the educated 
surgeon, of the careful and observing student, and of the 
well-trained nurse ; and that is the history of the progress 
of medicine in St. Bartholomew's Hospital. I should be 
sorry if I left you with any but very kindly feeling for 
the times and the men under whom seven hundred and 
fifty years ago our Hospital began. Their whole object 
was the relief and cure of patients. They desired to do 
all in their power for the sick man. In the midst of 
increased knowledge, of increased means of observation, 
of deeper interest in the phenomena of disease for their 
own sake, let us never forget that to do all we can for 
patients is the true end of medicine. 



PKINIKD BY ADLABD AND 60W, BARTHOLOIIBW CLOSE, B.C. 



Date Due 










































































































































Demco 293-5 



LSI 

Sou 2. 2. 



Accession no. 

HC 

Author 

Moore, Sir N. 
Progress of medicine 
at St. Bart's. 

Call no. 

Gt„ .Brit..